Behavior Modification Is Associated With Reduced Psychotropic Medication Use in Children With Aggression in Inpatient Treatment: A Retrospective Cohort Study

Carlson, Gabrielle A.; Chua, Jaclyn; Pan, Katherine; Hasan, Tahsin; Bied, Adam; Martin, Andrés; Klein, Daniel N.

doi:10.1016/j.jaac.2019.07.940

Cited by 36 publications

(22 citation statements)

References 37 publications

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“…Psychotropic PRN medications are often used with aim to control acute symptoms, particularly when safety is an issue, as is often the case on acute care units. Still there are questions about the efficacy of psychotropic PRN medications (Srivastava 2009; Baker and Carlson 2018) and there is evidence to suggest that other methods may be more effective for managing some symptoms (Carlson et al 2019). Given the common use that our results suggest, it is important for future research to closely examine the association between PRN use and a reduction in target symptoms.…”

Section: Resultsmentioning

confidence: 85%

Pro Re NataMedication Use in Acute Care Adolescent Psychiatric Unit

Saito

Eng

Grosso

et al. 2020

Journal of Child and Adolescent Psychopharmacology

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Objective: Evidence to support the use of pro re nata (PRN) medication is limited, and the details of PRN use (indication, frequency of administration, patient characteristics) are rarely reported, particularly in youth populations. The goal of this study was to report on the pattern of PRN use over 6 years in an acute care psychiatric unit for adolescents. Methods: A retrospective chart review of patients' records from November 2012 to October 2018 was conducted. Variables extracted from electronic medical records included age, gender, race/ethnicity, clinical rating scores at admission (on a subset of patients), length of stay, psychotropic and nonpsychotropic PRN medication administration, timing of administration, discharge diagnosis, and discharge medication. Results: Records from 2961 individuals with a total 3937 admissions were analyzed. A total of 62% of admissions had at least one PRN medication administration. Severity of symptoms, as indicated by higher scores on clinical rating scales at admission, longer length of stay, and readmission were related to high PRN use. Patients with bipolar spectrum disorders received more psychotropic and nonpsychotropic PRN medications than other patients. Patients who were high psychotropic PRN users were also high nonpsychotropic PRN users. Conclusion: Despite the lack of clear evidence in support of the efficacy of PRN medications, they commonly used to control symptoms in acute care inpatient settings. Youth with severe symptoms utilized not only psychotropic PRN medication but also nonpsychotropic PRN more frequently, suggesting a possible role of systemic disorder among youth with serious mental illness. More research is necessary to examine the efficacy of PRN medications for managing targeted symptoms.

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Section: Resultsmentioning

confidence: 85%

Pro Re NataMedication Use in Acute Care Adolescent Psychiatric Unit

Saito

Eng

Grosso

et al. 2020

Journal of Child and Adolescent Psychopharmacology

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“…We also tracked seclusion and restraint use on the unit, both with and without the behavior modification program. 24 However, using data from 510 children (aged 5À12) admitted for aggression in cohorts over 10 years, we found the following significant predictors of more outbursts/PRN use: no behavior modification program, only half-time child psychiatry attending, young age of the child, longer length of stay, and neuroleptic medication use. Predictors were similar for a higher number of seclusion and restraint use except that child psychiatry oversight was less relevant.…”

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confidence: 79%

Presidential Address: Emotion Dysregulation in Children and Adolescents

Carlson

2020

Journal of the American Academy of Child & Adolescent Psych

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“…Three types of Behavioral Management were used in three different reviewed articles: Modified Positive Behavioral Interventions and Supports (M-PBIS) [41], Behavior Modification Program (BMP) [42], and "behavioral modification plans" [43]:…”

Section: Behavioral Management Programsmentioning

confidence: 99%

“…3) Functional behavior assessments and individualized behavior plans for a small minority of patients who continued to have problematic behavior after problem-solving conversations [41] 2. The BMP was modeled for children with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), and included a points system, social reinforcement, time-out, and parent training [42].…”

Section: Behavioral Management Programsmentioning

confidence: 99%

“…(Table 1). Carlson et al (2020) [42] studied the effects of discontinuing the use of a BMP in an inpatient unit for children aged 5-12. The authors reported that the subsequent intervention after discontinuation of the BMP focused on talking the child down or distracting him/her from intensely emotional situations so that restrictive interventions would not be needed.…”

Section: Outcomementioning

confidence: 99%

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Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care

Perers¹,

Bäckström²,

Johansson

et al. 2021

Psychiatr Q

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Restraints and seclusions are restrictive interventions used in psychiatric inpatient units when there is an imminent risk of harm to the patient or others. Coercive measures are controversial and can lead to negative consequences, including negative emotions, re-traumatization, injuries, or death. The article summarizes the last 10 years of literature regarding methods and strategies used for reducing seclusions and restraints in child and adolescent psychiatric inpatient units, and reports on their outcomes. The literature was reviewed by searching PubMed and PsycInfo for English-language articles published between May 2010 and May 2020. Eighteen articles were found that described methods or strategies aimed at reducing restraint or seclusion utilization in child and adolescent psychiatric inpatient units. The following interventions were evaluated: Trauma-Informed Care (TIC), Six Core Strategies, Child and Family Centered Care (CFCC), Collaborative & Proactive Solutions (CPS), Strength-Based Care, Modified Positive Behavioral Interventions and Supports (M-PBIS), Behavioral Modification Program (BMP), Autism Spectrum Disorder Care Pathway (ASD-CP), Dialectical Behavior Therapy (DBT), sensory rooms, Mindfulness-Based Stress Reduction Training (MBSR) of staff, and Milieu Nurse-Client Shift Assignments. Most of the interventions reduced the use of seclusions and/or restraints. Two child-centered and trauma-informed initiatives eliminated the use of mechanical restraints. This review shows that the use of coercive measures can be reduced and should be prioritized. Successful implementation requires ongoing commitment on all levels of an organization and a willingness to learn. To facilitate comparisons, future models should evaluate different standardized parameters.

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Behavior Modification Is Associated With Reduced Psychotropic Medication Use in Children With Aggression in Inpatient Treatment: A Retrospective Cohort Study

Cited by 36 publications

References 37 publications

Pro Re NataMedication Use in Acute Care Adolescent Psychiatric Unit

Pro Re NataMedication Use in Acute Care Adolescent Psychiatric Unit

Presidential Address: Emotion Dysregulation in Children and Adolescents

Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care

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